抗环瓜氨酸肽抗体在类风湿关节炎诊断中的意义

目的：研究抗环瓜氨酸肽抗体（A—CCP抗体）在类风湿关节炎（RA）早期诊断中的意义。方法：对46例未肯定关节炎／关节痛患者，91例RA患者，45例其他风湿病患者，应用ELISA法检测血清A—CCP抗体，免疫散射比浊法检测RF，观察未肯定关节炎／关节痛患者6个月后转归情况。结果：A—CCP抗体对RA及未肯定关节炎／关节痛患者的敏感性和特异性分别为61．5％、95．6％和52．2％、95．6％；6个月后随访，46例未肯定关节炎／关节痛组患者中有32例为早期RA；A—CCP抗体在早期RA的阳性率为71．9％（23／32），95．8％（23／24）的未肯定关节炎／关节痛组A—CCP抗体阳性患者为早期RA；RA组RF诊断RA的敏感性高于A-CCP抗体（P=0．759），A-CCP抗体特异性明显高于RF（P=0．007）；联合检测A—CCP抗体和RF具有较高的特异性（97．8％），较单独检测RF具有更高的阳性预测值（P=0．026）。而未肯定关节炎／关节痛组A-CCP的敏感性、特异性和PPV明显高于RF，差异具有显著性或非常显著性意义（P=0．034、0．007,0．003）。结论：与RF比较，A-CCP抗体对早期RA具有较高的敏感性和特异性，有利于RA早期诊断，可作为RA早期诊断新的血清学指标。

Diagnostic Significance of Anti-cyclic Citrullinated Peptide Antibody in Rheumatoid Arthritis

Objective:To investigate the diagnostic significance of anti-cyclic citrullinated peptide(A-CCP) antibody in rheumatoid arthritis(RA).Methods:A-CCP antibody was detected by ELISA method and rheumatoid factor(RF) by BNP method in 91 cases of RA,46 cases of uncertain RA and 45 cases of other rheumatoid disease.Results:The sensitivity and specificity of A-CCP antibody in RA and uncertain RA were 61.5%,95.6% and 52.2%,95.6% respectively.In 46 cases of uncertain RA,32 cases were early RA after 6 months.The positive rate of A-CCP antibody in early RA was 71.9%.95.8% cases of uncertain RA with the positive A-CCP antibody was early RA.In cases of RA,the sensitivity of RF in diagnosing RA was higher than that of A-CCP antibody(P=0.759) and the specificity of A-CCP antibody was obviously higher than that of RF(P=0.007).The combination of A-CCP antibody and RF had a higher specificity(97.8%) and positive predictive value(PPV) than that of RF only(P=0.026).The sensitivity,specificity and PPV of A-CCP antibody in cases of uncertain RA were obviously higher than that of RF.The difference was P=0.034,P=0.007 and P=0.003 respectively.Conclusion:A-CCP antibody has higher sensitivity and specificity than RA in cases of early RA.It is a new serology index in diagnosing early RA.